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" Probably the use of the prepuce is to protect the delicate thin skin of the glans in animals who have no artificial clothing, and, of course, in man in his savage state. That it is not necessary for the purposes of the organ of which it makes a part, is evident by the variety in its natural figure, and by the frequency of circumcision. On this account, any impediment it may offer to the natural functions ought to be speedily removed. <4 But, however unimportant this covering of the glans penis,,

arising from it is now so well understood, that the difficulty of voiding the urine, occasioned by this state of the parts, is generally remedied by operation, before the patient attains the age of puberty. Where this has been neglected, diseases of the urethra and bladder have been the consequence.
Paraphymosis is a condition of the prepuce, in which it is already retracted, but cannot be returned to its original form. In this case it produces the effect of a ligature round the basis of the glans, and is, on that account, by some calletl Periphymosis. u When the phymosis is complete, no part of the glans, nor even the orifice of the urethra, can be discovered. This occurs sometimes in advanced age, apparently from a gradual shrinking of the penis; after which, the projecting orifice of the prepuce contracts to such a degree as to hinder the water from passing, even after it has escaped from the urethra. Hence, the whole cavity of the prepuce becomes filled with urine ; a small quantity of which, constantly covering the glans, deposits a calculous crust, assuming the figure of that part. " When the prepuce is thin, a division of the part with a phymosis knife, or curved bistoury, generally gives relief. When the prepuce is thicker, some have proposed an operation similar to that for the hare-lip, in order to obviate the deformity, from a separation of the two lamina of the skin : but, as the part is not, exposed to view, this appears unnecessary. e< Others prefer circumcision ; compressing as much of the prepuce as is necessary within the blades of the forceps, and cutting it off with one stroke of the knife.
In hot climates, where the inhabitants are most exposed to the inconvenience of morbid secretions from this part, Christians, as well as Jews, submit to this operation, according to an observation of Guido de Cauliaco,-? ' Propterea quod non congregantur sordities in radis balani et calefacerent ipsum.' ".Fallopius proposes a gradual dilatation, without any incision; /which, in some cases, may succeed. " When phymosis has existed a long time, adhesions take place between the glans and the prepuce, which cannot always be separated. 4' Sometimes, if the pus formed between the prepuce and glans cannot escape by the orifice, ulceration takes placc through the prepuce, by which the glans protrude, and the lower part of the no, 230. R r 306 Critical Analysis, prepuce is thrown to one side, resembling the finger of a glove* open at its extremity.
"The congenital phymosis in children sometimes goes off in adult age, the prepuce enlarging in greater proportion than the glans. An operation should not, therefore, be advised, unless other circumstances require it; though, to judge by my own experience, this natural cure of ihe constriction is of rare occurrence." Two plates follow, shewing the effects of phymosis on the urethra. Four specimens of disease in that membrane are given, where the general history affords no other probable cause than long continued resistance to its expulsitory power.
The upper portion of urethra in plate II. is a fungus, which in former times would have been denominated & caruncle. The lower portion exhibits a membranous band across the urethra, behind which is an oval ulceration. In many parts of these urethrae were appearances of disease atid inflammation, which, not producing alteration in the form and figure of the part, cannot be delineated by the pencil.
The two succeeding plates represent the state of the foreskin, where urine, each time it was voided, filling the cavity, and partly resting on the glans, gradually induced a deposition of calculous matter on that organ. The natural opening was obliterated by inflammation, and the urine could only escape with difficulty through ulcerations on the side and under part. Here circumcision was necessary, and, when performed, exposed a margin of fungus and calculous incrustation: the latter was easily removed, and the fungus afterwards by the application of caustic.
The sixth plate gives a representation of the effects of an -abscess between the two layers of the prepuce, with suitable remarks.
The seventh is an etching of a cancerous prepuce. Of -this the author speaks with some caution; and, as the subject has been so recently before us, we shall do him the credit to show, by the following extract, that he, at least, is not among the number of .those Avho are unmindful of their predecessors. *( Here were many of the characteristics of carcinoma. A sordid, sanious, fcetid discharge. The erosions betwixt the fungi bled from time to time, and the serrated, indurated, retorted edge, presented the external marks of cancer.
? Many apparently trifling diseases of these parts, whether ^arising from mal-formation or want of cleanliness, derive their importance from their situation. Of this class are herpetic affec-iions of the skin, and ulceration from the lodgements of the mucous secrction between the contracted prepuce and the penis. These, when remarked with sufficient accuracy, may be always distinguished from syphilis. It is not so easy to describe them by appropriate character. Till Mr. Hunter's time, there was no difficulty, because they were all called venereal. A celebrated French author said formerly,?' On peut assurer que quand trente mille hommes combattent en bataille rangee contre des troupes egales en nombre, il y a environ Vingt mille Veroles de chaque cdte ?but grande verole, lues, and pox, are now obsolete terms.
Writers have been ashamed to confound what Mr. Hunter sepa. rated with so much accuracy; and, by slow degrees, the true venereal ulcer has been tolerably well ascertained. But a new language has been introduced, and threatens to confound all other distinctions. We had long been accustomed to the word proteifortn, which proved a most convenient salvo, till Mr. Hunter shewed the uniformity of nature in this as in all other causes and effects. Pseudo-syphilis now removes us a single step, and no more, in our labyrinth ; but, what is much worse, it proves an apology for resting, instead of proceeding and marking our way. Mr. Hunter, though he gave no names to the other numerous complaints of this organ, yet described them with accuracy, so that, when we meet with them, we recognise what we have seen in his writings. If we are still at a loss for names, there is reason to believe most of them may be found in Celsus: see his chapter, De obsccenarum partium vitiis. Such is not, however, the case with the two following.
x The plate to which the close of the foregoing extract refers, gives a representation of the enlarged prepuce, so common in the West-India islands, particularly in Barbadoes, as to be almost endemic. This, as the author observes, is, by the moderns, termed elephantiasis, when seated in the foot and leg. The other remarks are very judicious, and the references to the best authors not less copious. To render the illustrations more perspicuous, this case is followed by a figure of the penis under the elephantiasis of Aretasus, in which that organ appears somewhat retracted within the pubes, which is free from hair, and the prepuce appears elongated by the retraction and, probably, wasting of the glans within it. Aretasus (observes Mr. Wadd) is allowed to be the first author who notices this disease, and his description has been copied by every subsequent writer, till our own days. For the most part, it is admitted to be correct. If it is deficient in the parts under consideration, it should be remembered, that the author acknowledges his fear of contagion, which probably prevented his closer examination: nor is it unlikely that, when he speaks of the Rl*a : 308 ' Critical Analysis. salaciousness of these unhappy creatures, he only relates a vulgar error.
A case of this kind lately occurred in St. Bartholomew's Hospital, and is related in the Medico-Chirurgical Transactions, vol. vi.
I did not see it, but the following is the description given by Mr. Lawrence :?' Not only had the development of the generative organs been arrested from the time when the disease broke out, but they had actually undergone diminution and decay. The scrotum was shrivelled, and seemed empty ; the testes could with difficulty be felt; they were soft, and about the size of small horse-beans." The present number introduces the Affections of the Scrotum, and closes with two most interesting plates of a disease, we believe, not before accurately represented on paper, and at present particularly requiring the attention of the faculty, on account of parliamentary enquiry. This is the chimney-sweepers' cancer, of which four representar tions are given in its different forms. We cannot admit space to enlarge on the author's pathology of the disease, which is to us not less satisfactory than perspicuous.
Such are the contents of this number, of which, bv several hints interspersed, we expect a continued series. We sincerely hope Mr Wadd will improve the leisure of the succeeding summers, as he has done the last. During the Winter (to speak professionally) he is probably much better employed. This little pamphlet contains some passages which we shall only transcribe. The character of Dr. Vetch, as an able writer, is known to most of our readers ; and the very extensive practice with which he has been so long entrusted at the army depot, is not a little to his credit. The work commences with a few very appropriate remarks on the difference between an epidemic ophthalmia among girls at the well-regulated Military \>vluu>, and soldiers in the highest health, at the most vigorous* period of life, often-times artificially animated and with great difficulty restrained from intemperance. In such subjects, Dr. v. asserts, that the free use of the lancet should precede every tle, convinced as I am, that even he himself, should he ever see a case of real Egyptian Ophthalmia, in its violent and purulent stage, "Will not venture to place his principal trust in such a remedy." i( I proceed to examine (continues our author) the nature and the efficacy of the discovery, claimed by Sir William Adams, for the cure of opaque cornea. With respect to his present practice, 1 must presume, that he either adheres to his original plan of treatment by excision, which I have declared, and which I can now prove to be from his own evidence, (independent of many objections to its general application) incompetent of itself to the cure of the disease; or, that he is forced to combine with the operation those very means which it was introduced to supersede, and of which, I may venture to say, that Sir William Adams has still something to learn, both as to their value, and their proper mode of application.* I shall, therefore, in the first place, submit some general observations respecting the disease itself; and, in the second place, 1 shall review the statements, now published, of its practical results. 44 It has been objected to the claims of Sir William Adams, that he took the knowledge of the operation from the practice of the late Mr. Saunders; I must, in justice to myself, observe, that in my Account of the Ophthalmia of the Army, printed in 1S06, when it would be easy to prove that I could not have had access to the opinions or practice of Mr. Saunders, I distinctly, and prior to any modern writer, made use of the term of Granular Surface, to describe the diseased state of the linings of the palpebra, which supervenes on purulent ophthalmia; and explicitly mentioned the Jbad effects resulting fropi the excision of the surface so diseased, and the means which I then found, and still assert, to be better adapted to the purpose of restorjng the membrane to its healthy condition.
My subsequent experience rendered the cure of "* In the month of September 1816, Sir William Adams admitted to a patient (who, in consequence of that admission, put himself under my care) that there were but two ways of applyiug caustic for the cure of opaque cornea;?one was by dropping a solution of it into the eye, which he actually ordered ; the other, he Said, would be so violent in its operation, as to occasion excruciating pain, and endanger the safety of the eye. I refer to the case of the Honourable Captain C , R. N.
The success which immediatrl) attended the use of caustic in this case, without causing pither pain, risque, or even momentary confinement, only shows S10 Critical Analysis.
opaque cornea, depending on that diseased state of the palpebral linings, so much a matter of uniform result at the Ophthalmia Hospital, that long before I heard that there was such a person as Sir William Adams, I had no reason to doubt but that my success was both understood and appreciated.* " If it be objected to these early operations that the scissors were used instead of the knife, I beg to say, that both these instruments had been repeatedly employed ; and 1 do not scruple to assert, that, where the operation is required, the scissors are the better instrument of the two; that the surface which follows excision* by them is less irritable, and less disposed to a reproduction of fungus; that there is also less risque of wounding the semilunar cartilage of the palpebra;, an accident very likely to occur in the mode of operating performed by Sir William Adams, and which I apprehend to have happened in some cases where the operation has led to a termination fatal to the organ.
u The cure of this granulated surface of the palpebraj, by means of excision, is mentioned by Hippocrates; and the disease under the names of sycosis and scabies ?palpebrarum is distinctly described by the succeeding authors of the Greek and Latin schools; and the cure as precisely directed by the three methods of excision, abrasion, and cauterisation. The Arabian authors arc still moro minute in their details respecting the treatment of opaque cornea, under the term sebel, nor has it been left to modern times to suggest any improvement even in the mode of operating." il The names of the two men whom Sir William Adams omits to notice in his published report, are, William Wells of the fiftysecond, and Sergeant Treble of the forty-third, regiments: these men Sir William Adams found it expedient to reject, after having kept them for a month under his treatment, on the frivolous pretext that caustic had been applied to them by the officer who succeeded me in charge of the Ophthalmic Hospital. Of the three re-> maining cases, John Winter is reported to be cured, and, according to the promise given, is discharged with a pension; John Capel is dismissed with one eye. ' irrecoverably lost /' and David Grey ivith Qn\y one eye improved, after the lapse of two years and three months? il I shall afl'ord each of these cases a separate examination. 44  company Mr. Weir to the York Hospital, but without seeing either Sir William Adams or his practice, farther than the former was pointed out to me at a distance too great for me to know one person from another. version of the upper eyelid, but no mention is made of the left eye being different from the right. The state of fhis man is farther reported by my /successor at the hospital, as one of simple opaque cornea, with diseased linings of the palpebraa. That Sir William Adams should lose an eye by the operation, does not surprise me; but, if the statements I have quoted are correct, his attempt to conceal the misfortune, by such a subterfuge, is what I could not expect. It is not enough for Sir William Adams to say, or rather to prove, that he did not perform the operation on the left eye, as he must be well aware that the inflammation excited by the operation in one eye, might very possibly lead to such a return of active disease in the other, as would, in the debilitated state of the organ^ eventually occasion its '  The subject of Calculary Concretion is one of considerable interest, both to the physiologist and medical practitioner ; and the recent improvements in chemical analysis and manipulations have given a precision and scientific character to * these investigations, which, as we observed in our last Retrospect, could not be in better hands than in Dr. Marcet's.
The first section is devoted to the consideration of the <l different situations in which calculi are found in the urinary passages, and the symptoms which they respectively Produce." The kidneys, the bladder, the prostate gland, the urethra, are all parts in which such concretions are Jikely, at different times, to lodge. Long continued pain in the region of the kidneys, accompanied eventually by purulent discharge, sometimes with copious hgemorrhage, are indications that a stone exists in the kidney; but, as very Justly remarked by our author, these concretions sometimes take place in this organ, and arrive at a very great size, without such marks which, a priori, would be imagined necessary ; and it must also be recollected, that pain, haemorrhage, and, eventually, purulent discharges, may occur from irritations independent on calculus. regard to the actual existence of stone in the prostate, Dr. Marcet well observes, that a decisive diagnostic is still wanting. Sometimes, however, as in a case related by our author from Mr. A. Cooper, the fact may be ascertained by manual examination ; and these obstructing bodies, when they are in the urethra, cannot fail of being soon discovered by unequivocal marks.
The second chapter is occupied by an investigation of the comparative frequency of calculous concretions in different countries, with a view to ascertain, if possible, upon what particular circumstances of excitement the disease depends.
Our author's inferences are, that no peculiarity of diet or drink, to which calculous formations and deposits have been attributed, can be justly regarded as producing any specific influence on their production. One fact Dr. Marcet's investigations served to prove; viz.?that, in hot and tropical climates, the diseases in question are much less frequent than in more northern latitudes; and hence he conceives that .there may be some hitherto unobserved connexion between thfe excretion from the surface and the condition of the urinary organs, which favours the generation of stone. He afterwards proposes a practical deduction from this circum-with Dr. Henry's suggestion) assume this circumstancc as the distinguishing quality of an additional species of urinary concretions. Upon the whole, therefore, the different kinds of urinary calculi may be arranged under the following heads, viz.? " 1. The lithic calculus; " 2. The bone-earth calculus, principally consisting of phosphat of lime; <c 3. The ammoniaco-magnesian phosphat, or calculus in which this triple salt obviously prevails; 44 4. The fusible calculus, consisting of a mixture of the two former; " 5. The mulberry calculus, or oxalat of lime; " 6. The cystic calculus, consisting of the substance called, by Dr. Wollaston, cystic oxyd ; u 7. The alternating calculus, or concretion composed of two or more different species, arranged in alternate layers ; <c 8. The compound calculus, the ingredients of which are so intimately mixed as not to be separable without chemical analysis. <c Q. Calculus from the prostate gland." After entering into a somewhat minute detail of the chemical properties of these several species, Dr. Marcet de-* scribes two non-descript calculi which he has met with, but which are not capable of being referred to any of the above divisions: one of these he proposes to name the xanthic oxyd calculus, and the other the fibrinous; the former being apparently composed of an oxyd, and forming a lemon coloured compound when acted upon by nitric acid ; the latter being possessed of those properties which correspond exactly to those of fibrine.
With respect to the comparative frequency of the different species of calculi, which is the next topic of Dr. Marcet's investigation, he makes the following inferences as the result of his researches. " It would, therefore, appear, so far as depends upon the evidence of this document (a document from the Norwich collection), that the lithic calculus, which Scheele supposed to be the only species of urinary concretion, constitutes hardly one-third of the total number of stones which occur in the urinary passages ; and that the fusible comes next, in regard to frequency. It appears, also, that the number of either the fusible or mulberry calculi amount only to about two-thirds of the number of the lithic calculi j flnd that those concretions which are evidently of a compound nature amount only to about one-half of the mulberry species. It will be also observed (adds Dr. M.) that by far the greatest proportions of deaths has been amongst patients labouring under calculi of the compound or mixed kind ; and I am enabled to add^ by a more particular reference to my notes, that ?o less Dr. Marcet on Calculous Disorders. 317 than five deaths were annexed to the fifteen cases of alternating lithic acid and oxalat of lime ; whilst, contrary to all expectation, the strongly characterised mulberry, with its usual rough tubercular surface, yielded a much smaller proportion of fatal cases than any other species. This result is the more curious, as it seems to show that it is not so much the mechanical irritations of the stone, as the particular diathesis of the urinary secretion, which influences the event of the operation." The tests of discrimination in each species, upon which our author next treats, are briefly the following.?Take a fragment of the stone which you conceive to be formed of the lithic acid; expose it to the flame of a blow-pipe, and, if a lithic calculus, it will immediately blacken, emit asmoke of a strong characteristic odour, and be gradually consumed. Secondly, put another fragment of the same concretion in a glass vessel, and pour some caustic, or pure alkali, upon it, which, with the assistance of heat, will readily dissolve it. Lastly, add only a drop of nitric acid on a small particle of lithic calculus, and, adding heat, the lithic acid "frill immediately disappear.
The phosphate of lime calculus is to be discovered by its first blackening before the flame of the blow-pipe, but soon afterwards becoming perfectly white, and not fusing, unless by very intense heat. The muriatic acid is a ready solvent of this species of calculus. The ammoniaco-magnesian phosphat will lose its ammoniacal principle by the heat of the blow-pipe, and the remaining parts, which aie a phosphat of magnesia, become opaque, and may be imperfectly fused. This calculus may be dissolved more easily in dilute acids, than even the phosphat of lime. When the fusible calculus is exposed to the flame of a blow-pipe, it melts, bubbles up, and runs into globules of a pearly appearance.
This calculus, likewise, is of easy solution in the acids. The mulberry calculus is, for the most part, sufficiently obvious by its external characters. " Its most obvious chemical character is to swell out when exposed to heat, and to expand into a kind of white efflorescence, which, when brought mto contact with paper stained with the juice of violets, and slightly moistened, turns it green." The waxy appearance the cystic oxyd stone, its peculiar smell when heated, and Jts easy solubility, both in acids and in alkalies, constitute its principal features of distinction.
iiefore engaging in the consideration of the treatment of calculous disorders, Dr. Marcet occupies a.section of his work with noticing " some other kinds of animal concretions, not belonging to the urinary passages, both in man and other animals." Of these, he particularizes concretions 318 Critical Analysis.
in the salivary glands, which, according to Fourcroy and Bostock, " consist of phosphat of lime, Avith small portions of animal matter j" intestinal concretions, which, in the human subject, are rare, and possess very little distinctive character; calculi from the intestines of quadrupeds, which may be generally stated to consist of the ammoniacomagnesian phosphat urinary concretions of animals, which generally differ from those of the human subject in containing no lithic acid, and in consisting principally of carbonat and phosphat of lime, cemented by animal matter.
Indeed, we are told that the lithic acid has never been discovered in any animal concretions, except in man, il till Dr. Prout analysed the excrement of the boa-constrictor, and found that substance to yield upwards of nine-tenths of its weight of lithic acid, and to contain ammonia." With respect to gouty concretions, these have long been ascertained to consist of lithic acid and soda. Biliary calculi, "which are the last substances mentioned by our author, are constituted mainly of the substance called, by Fourcroy, adipoccre, from being a kind of sui-generis principle, seemingly between wax and fat. * In the last chapter, Dr. Marcet discusses the treatment of calculous complaints. This discussion he introduces by the following candid admissions and philosophical remarks. " On my entering upon this subject, I think it necessary to premise that, in endeavouring to apply chemical principles to this branch of medical practice, no reasonable expectation can be entertained that calculi, lodged in the urinary organs, and already too large to be discharged by the natural passages, can be actually dissolved by any mode of internal treatment. The only benefit "which we may, with any confidence, expect from medicine in this disease is, either to prevent the increase of calculi already formed, or, what is still more important, to guard the constitution of those "who are subject to the disorder, against the prevalence of the particular diathesis from which it arises.
But, although we cannot materially affect large concretions by medicines, on account of the powerful resistance which the cohesive force of such calculi, and the small extent of surface which they present in proportion to their mass, necessarily oppose; yet there certainly are cases in which some impression may be made upon small calculi, or gravel, so as to blunt their sharp edges, and enable them to be discharged by the urethra with less difficulty or inconvenience. At all events, since, in attempting to remove calculi, we have to contend against unorganised bodies, which, though contained in living parts, do not obey the laws of the living principle, it may be fairly concluded, that, unless surgical aid be resorted to, it is, in a great measure, from chemical principles that our views of treatment ipust be derived." Dr. Marcet on Calculous Disorders. 319 It is well known that doubts have been entertained and ?expressed as to the possibility of any direct influence upon "the urine, or urinary concretions, by substances taken into the stomach ; and an inference has been adduced from such doubts, of the fallacy of those expectations which calculate upon the corrective virtue of reputed solvents, or remedies for stone and gravel. But it is an actual fact, resting upon the most authoritative testimony, that " alkaline medicines Will not only deprive the urine of its acid properties, but will render it decidedly alkaline." This fact was proved, in a very satisfactory manner, by the Bishop of Landaff, who, while taking lime-water for a cure of stone in the bladder, poured his urine, every morning and evening, upon a piece of human calculus, weighing thirty-four grains, by which, in the space of four months, it was reduced to three pieces, weighing in all six grains. But it may be said, that this solution might have been effected by common urine. To prove this not to be the case, the Bishop caused to be daily poured, for two months, upon a piece of the same calculus, the urine of a person who drank no lime-water ; at the end of which time, the substance was found to have increased, instead of undergoing diminution :?a clear demonstration this of the principle contended for, viz.?that certain substances, taken into the stomach, actually produce a direct chemical change upon the urinary secretion. A case, published more recently by Dr. Bostock, serves indubitably to establish the same assumption; and " Mr. Brande has shewn that alkalescence in the urine is produced within a few minutes after taking the alkalies, whether they be in a caustic or pure state." <c With regard to the acids, (says our author,) the question is not so easily resolved. For, as the urine is naturally acid, and especially contains portions both of the muriatic and sulphuric acids, which are those commonly used as medicines, any small increase of either of these acids in the urine, in consequence of their being taken into the stomach, cannot be so readily ascertained.
It is, however, stated by some chemists, and in particular by Mr. Brande, that acids taken into the stomach arc actually capable of being conveyed into the bladder ; and this he has more especially endeavoured to ascertain, by experiment, with regard to the carbonic acid. Unfortunately, however, (our author adds, in the same spirit of candour which is exhibited in the extract above made,) although alkalies do certainly, and acids may possibly, reach the Urinary passages, yet experience has shewn that the quantity of either, thus conveyed through the circulation, is so small, that very little, if any, impression can be made on large pre-existing calculi, S20 Critical Analysis. N with whatever freedom or perseverance these medicines may be used. But there is abundant evidence to prove that we are able, in many instances, to produce an effect sufficient to check the prevailing diathesis, and also sometimes to bring on a calculous deposit, depending upon an opposite state of the system; a change which I have myself repeatedly witnessed." extent, and more generally than has hitherto been done.
We regard tins treatise as very creditable to the author's abilities and acquirements. The plates are most exquisitely executed; and, although they add, of course, considerably to the expense of the publication, they certainly increase its Value in the same proportion. The number of men, on whose experimental accuracy we can depend, throughout Europe, is small compared with the number of experimenters. It is, therefore, fortunate, when more than one of the same description are about the same time engaged in similar pursuits, and peculiarly satisfactory, if the result from the enquiries of each should be similar.
In this paper, Dr. Prout confines his attention to urea, saccharine matter, and the lithic or uric acid. 44 The other principles, particularly the phosphates and oxalic acid, are omitted from the uncertainty which still hangs over their Carbon and oxygen in a given weight of sugar are precisely twice those in urea. " 4. Lithic acid is a substance quite distinct from urea in its composition. A fact, which explains an observation I have often made, that an excess of urea generally accompanies the phosphoric diathesis, and not the lithic. I have several times seen urea so abundant in the urine of a person where the phosphoric diathesis prevailed, as to crystallize spontaneously without being concentrated by evaporation, on the addition of nitric acid. <c I shall forbear at present to notice other interesting circumstances suggested by the present enquiry, lest, in this early stage of it, they might be considered as visionary and hypothetical. Thcsfr analyses, however, appear t9 me to afford glimpses of laws that will hereafter be found to influence the whole system of Nature's operations.
"Section 2.?Some Remarks upon the Efficacy of General Remedies, and especially Purgatives, in ensuring a Healthy State of the Urinary Secretion, and thus in preventing Calculous Affections.
have been accustomed to exhibit a combination of the pil. hydrarg. "with aloes, or the ext. colocynth. c. with the best effect. Remedies determining to the skin and kidneys are often useful adjuncts, and a regimen in strict unison with the same general principles should be adopted. 44 I need hardly remark, that the above observations are almost entirely confined to diseases of the urine, while as yet they are merely constitutional, and have not produced local disease, or actual calculus. To the treatment of such unfortunate cases, I have nothing to add to the little already known. When a calculus is once formed, its further enlargement is, probably, a common chemical process, and will proceed, whether the urine be healthy or not, for all urine naturally contains the ingredients most commonly met with in calculi. Something, however, may be possibly done by general remedies in retarding its growth; but this will only prolong the patient's misery, who had much better, therefore, submit at once to the operation, and, by subsequent attention to the above principles, prevent the future formation of another.
Medico-Chirurgical Transactions. 327 cloths, Accordingly, to make the trial,* I dissolved two ounccs and a half of manna in a quart of whey, and drank it, and took a little lemon-juice between whiles, as well to make it operate more speedily, it being ordinarily a slow purgative, as to render it more agreeable to the stomach. It is hard to express the ease I perceived in the region of the kidnies from this medicine; for, though thepain'was not continual before, yet [ felt a troublesome weight. Kncouraged by this good success, I took this purgative every week on a set day, for some months, and found a manifest amendment after every purge, till at length I could bear the shaking of a coach when the horses went apace; and, indeed, continued free from this symptom till last spring, at the beginning of which it returned, occasioned by my having had the gout severely all the preceding winter, and my inability to motion, which made me indulge rest, and use less exercise than usual. And now 1 doubted whether I should have recourse to purging again, as finding that the mildest purge certainly occasioned a fit of the gout, because the whole substance of my body, in these latter years, had, in a manner, degenerated into nourishment for this distemper. But, at length, it came into my mind, that I might safely resume my former method of taking manna once a week, provided I took an opiate in the evening after the operation, to quiet the tumult raised by the purgative. Accordingly, in the morning I drank two ounces and a half of manna, dissolved in a quart of whey ; and, at night, took sixteen drops of liquid laudanum in small beer; and repeated the manna and laudanum, in this manner, twice a week, for three "weeks running. But afterwards I took the manna only once a week, because it had discharged such plenty of foul humours as to leave little fear of the gout. And my reason telling me, that, if manna was possessed of any stone-dissolving or stone-breaking virtue, its efficacy, on which I depended, must needs be lessened, in some measure, by so powerful an astringent as laudanum is, I thought it best to omit taking the opiate, as I only purged once a ^reek."?Sydenham, p. 532-533.
By such a remedy it is not unreasonable to conclude, that, action and secretion being excited in different organs, a disease may cease in those which were previously affected, and that the parts may be protected from the irritation of the previously formed stone, in the manner described by Dr. Marcet. This is only one of the considerations we wish to impress on our readers. Whatever alters action in a chronic disease is likely to supersede such diseased action, and consequently to restore healthy action. In this manner only, alterative doses of mercury produce their salutary effect, and ^VQuld be unobjectionable, if it were not for the high irritability induced by a frequent repetition of such a remedy.
Laxatives are unattended with such danger, and, in our opinion, are more certain in their good effects. *? See his Catalogue of English Plants.
Commentatio de Pathologia Lienis, Observationibus per jinatomen institutes, indagata, ad illustrandam Physiologiam cenigmatici hujus visceris. Auctore C. L. Schmidt, Gottingae. 1816. The object of this dissertation is to illustrate the physiology of the spleen, by observations relating to its structure and diseases. An exact description of the situation, form, usual magnitude, and weight, of this organ is first given ; also of its lymphatic vessels, nerves, and especially of its great artery and vein.
The diseases of the spleen have been neglected or mistaken, from being confounded with those of other parts. The vomitting of blood, dyspepsia, difficulty of breathing, have been considered as symptoms of different diseases ; and the unfrequency of a fatal termination has prevented the truth from being discovered after death. Yet the derangements of the spleen are so common, that it is more rare to find it in a sound than in a diseased state. The inflammations of this organ are divided into acute and chronic; the acute inflammation varying as to its extent, through the whole, or confined to a portion, is either universal or partial: and, as other viscera are occasionally inflamed at the same time, it is also to be considered as simple or complicated.
As the inflammation of an abdominal organ is rarely confined to that organ during its whole course, it will be difficult to distinguish the acute inflammation of the spleen from that of other parts, except in the earliest stage: nor is it of much consequence. It appears that persons of both sexes and of all ages are liable to the complaint, but it most frequently occurs in females, who are affected with a deficiency or entire suppression of the menstrual evacuation ; that the melancholic temperament is more disposed to it than the sanguine j and that it is observed most frequently in humid and warm countries, such as Hungary, Bengal, and Italy. The occasional causes are such as the application of cold to the feet or breast, a concussion, a blow, a fall, suppression of the menstrual or hemorrhoidal fluxes, or of any Other customary discharge of blood.
inflammation of the spleen is preceded by the following symptoms :?The patient becomes dull, morose, and inclined to anger; there is a sense of uneasiness in the prsecordium, an aversion to food, and a difficulty in digesting it; the countenance becomes pale, livid, and often, from the sympathetic affection with the liver, of a yellow colour. To these symptoms are added chills, followed by heat; the patient is uneasy, and cannot rest either on the right or on the left side, but